Letters to Editor Page | 306 Access this article online
REFERENCES
Quick Response Code:
1.
2.
Kalan A, Tariq M. Foreign bodies in the nasal cavities: A comprehensive review of the aetiology, diagnostic pointers, and therapeutic measures. Postgrad Med J 2000;76:484-7. Horng HC, Hsu YC, Wong CS, Su WF, Cherng CH. Iatrogenic Foreign Body (Cotton Swab) in the Trachea after Nasotracheal Intubation. J Med Sci 2009;29:285-7.
Website: www.saudija.org
DOI: 10.4103/1658-354X.130761
Pulsus alternans: Real and pseudo CASE 1 An 18-year-old male patient was diagnosed as rheumatic heart disease with severe AR and MR. He was on enalapril as vasodilator preoperatively. Pulse was irregular and collapsing. He was scheduled for valve replacement surgery. Preinduction radial arterial line was inserted. Arterial waveform was peculiar — one greater amplitude peak was followed by one lesser amplitude peak alternately [Figure 1]. This was mimicking pulsus alternans.
Figure 1: Arterial waveform with alternate greater and lesser amplitude wave (marked by yellow arrow)
CASE 2 A 60-year-old male patient after coronary artery bypass grafting was having large and small amplitude arterial waveform [Figure 2]. This waveform was appearing as pulsus alternans. Pulsus alternans is generally seen in left ventricle dysfunction. In case 2, ECG rhythm was bigeminy. Every normal QRS was giving rise to normal arterial pulse wave and every premature ventricular contraction was corresponding to lower amplitude arterial wave. This pattern created pulsus alternans. In case 1, as patient was already vasodilated, there was peripheral run off. So diastolic phase of arterial pulse is prolonged, appearing as 2nd lower amplitude arterial wave. This lower amplitude wave did not correspond to QRS in ECG. Such a waveform can be misdiagnosed as pulsus alternans.
Figure 2: Bigeminy ECG rhythm with alternate greater and lesser amplitude wave (marked by yellow arrow)
Address for correspondence: Dr. Monish S. Raut, Department of Cardiac Anesthesia, Dharam Vira Heart Center, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi - 110 060, India. E- mail: [email protected] Access this article online Quick Response Code:
Website: www.saudija.org
Monish S. Raut, Arun Maheshwari Department of Cardiac Anesthesia, Dharam Vira Heart Center, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India
Vol. 8, Issue 2, April-June 2014
DOI: 10.4103/1658-354X.130762
Saudi Journal of Anesthesia
Copyright of Saudi Journal of Anaesthesia is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
REFERENCES
Quick Response Code:
1.
2.
Kalan A, Tariq M. Foreign bodies in the nasal cavities: A comprehensive review of the aetiology, diagnostic pointers, and therapeutic measures. Postgrad Med J 2000;76:484-7. Horng HC, Hsu YC, Wong CS, Su WF, Cherng CH. Iatrogenic Foreign Body (Cotton Swab) in the Trachea after Nasotracheal Intubation. J Med Sci 2009;29:285-7.
Website: www.saudija.org
DOI: 10.4103/1658-354X.130761
Pulsus alternans: Real and pseudo CASE 1 An 18-year-old male patient was diagnosed as rheumatic heart disease with severe AR and MR. He was on enalapril as vasodilator preoperatively. Pulse was irregular and collapsing. He was scheduled for valve replacement surgery. Preinduction radial arterial line was inserted. Arterial waveform was peculiar — one greater amplitude peak was followed by one lesser amplitude peak alternately [Figure 1]. This was mimicking pulsus alternans.
Figure 1: Arterial waveform with alternate greater and lesser amplitude wave (marked by yellow arrow)
CASE 2 A 60-year-old male patient after coronary artery bypass grafting was having large and small amplitude arterial waveform [Figure 2]. This waveform was appearing as pulsus alternans. Pulsus alternans is generally seen in left ventricle dysfunction. In case 2, ECG rhythm was bigeminy. Every normal QRS was giving rise to normal arterial pulse wave and every premature ventricular contraction was corresponding to lower amplitude arterial wave. This pattern created pulsus alternans. In case 1, as patient was already vasodilated, there was peripheral run off. So diastolic phase of arterial pulse is prolonged, appearing as 2nd lower amplitude arterial wave. This lower amplitude wave did not correspond to QRS in ECG. Such a waveform can be misdiagnosed as pulsus alternans.
Figure 2: Bigeminy ECG rhythm with alternate greater and lesser amplitude wave (marked by yellow arrow)
Address for correspondence: Dr. Monish S. Raut, Department of Cardiac Anesthesia, Dharam Vira Heart Center, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi - 110 060, India. E- mail: [email protected] Access this article online Quick Response Code:
Website: www.saudija.org
Monish S. Raut, Arun Maheshwari Department of Cardiac Anesthesia, Dharam Vira Heart Center, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India
Vol. 8, Issue 2, April-June 2014
DOI: 10.4103/1658-354X.130762
Saudi Journal of Anesthesia
Copyright of Saudi Journal of Anaesthesia is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
